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Compound monograph · evidence extract

Tirzepatide in knee osteoarthritis with obesity — evidence extract

The Institute's graded assessment of Tirzepatide for knee osteoarthritis with obesity, with the contributing trials and the domain-by-domain certainty reasoning.

Document identifier
CEI-MN-003/EV-KNEE-OA
Series
Evidence extract
Version
4.2
Published
16 Jan 2024
Last reviewed
16 Jan 2025
Next review
16 Jan 2027
Identifier
10.71829/cei.mono.3
Certainty
Low
Cycle
2024 Q1

§1Evidence extract: Knee osteoarthritis with obesity

§1.1Question and anchor outcome

Population
Degenerative joint disease of the knee with radiographic or symptomatic confirmation, occurring with obesity as a mechanical and inflammatory contributor.
Intervention
Tirzepatide, subcutaneous once weekly
Comparator
As used in each contributing trial; reported per trial rather than pooled across comparator types
Anchor outcome
WOMAC pain subscale

Additional outcomes the Institute extracts for this indication: Physical function score; Analgesic use; Progression to arthroplasty.

§1.2Contributing trials

Table 1. Trials contributing to the assessment of Tirzepatide in knee osteoarthritis with obesity.

TrialPhaseDesignRandomisedDurationYear
SURMOUNT-KOA3Randomised, double-blind, placebo-controlled68 weeks2025

§1.3Certainty assessment

Certainty assessment by domainDowngrading decision recorded for each certainty domain.Certainty domainNo concernSeriousVery seriousEffect on ratingRisk of biasno downgradeInconsistencyno downgradeIndirectnessno downgradeImprecisionno downgradePublication biasdowngrade two levelsTotal downgrading: 2 levelsLow certainty
Figure 2. Domain-by-domain certainty assessment for Tirzepatide in knee osteoarthritis with obesity. The starting rating for a body of randomised evidence is high; each serious concern reduces it by one level and each very serious concern by two.

Table 2. Reasoning recorded against each certainty domain.

DomainRatingReasoning
Risk of biasNo concernNo serious concern identified in this domain.
InconsistencyNo concernNo serious concern identified in this domain.
IndirectnessNo concernNo serious concern identified in this domain.
ImprecisionNo concernNo serious concern identified in this domain.
Publication biasVery seriousRegistered trials without posted results were identified for this question.
Overall rating: Low certainty. Confidence in the effect estimate is limited. The true effect may be substantially different from the estimate.

§1.4What this extract does not establish

References cited on this page

References are numbered in order of first citation in this document. Each superscript in the text links to its entry below.

  1. Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, Kiyosue A, Zhang S, Liu B, Bunck MC, Stefanski A. Tirzepatide once weekly for the treatment of obesity. New England Journal of Medicine 2022;387(3):205–216. doi:10.1056/NEJMoa2206038 · PMID 35658024
  2. Garvey WT, Frias JP, Jastreboff AM, le Roux CW, Sattar N, Aizenberg D, Mao H, Zhang S, Ahmad NN, Bunck MC, Benabbad I, Zhang XM. Tirzepatide once weekly for the treatment of obesity in people with type 2 diabetes (SURMOUNT-2): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial. The Lancet 2023;402(10402):613–626. doi:10.1016/S0140-6736(23)01200-X · PMID 37385275
  3. Wadden TA, Chao AM, Machineni S, Kushner R, Ard J, Srivastava G, Halpern B, Zhang S, Chen J, Bunck MC, Ahmad NN, Forrester T. Tirzepatide after intensive lifestyle intervention in adults with overweight or obesity: the SURMOUNT-3 phase 3 trial. Nature Medicine 2023;29(11):2909–2918. doi:10.1038/s41591-023-02597-w · PMID 37840095

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